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Babies Spitting Up—Normal in Most Cases

Anyone who's ever taken care of an infant knows that babies spit up. And spit up. And then spit up again.

It's easy to understand why some parents and other caretakers are concerned. Is the infant getting enough nourishment? Is frequent spitting up a sign of a more serious illness? Does the baby need medicine to treat the problem?

According to Andrew E. Mulberg, M.D, a pediatrician and pediatric gastroenterologist at the Food and Drug Administration (FDA), frequent spitting up is absolutely normal in most cases and not a symptom of poor health. As long as the child is alert, reasonably content, gaining weight, and not showing other signs of illness, this is not usually a cause for concern, he says.

So what is causing the baby's food to come back up so frequently?

In infants, the ring of muscle between the esophagus and the stomach—the lower esophageal sphincter (LES)—is not fully mature, allowing stomach contents to flow backward, Mulberg explains. In time, the LES will mature and open only when the baby swallows and will remain tightly closed the rest of the time, keeping stomach contents where they belong.

"By the time the child is 18 months of age or younger, the problem—known as gastroesophageal reflux (GER)—usually resolves itself," Mulberg says.

In a small number of cases, a more serious condition known as GERD (gastroesophageal reflux disease) may exist. GERD also can cause excessive spitting up, but requires treatment to avoid additional health complications, such as tissue damage in the lining of the esophagus. A health care professional should be consulted immediately if a baby shows such symptoms as spitting up blood, blood in the stool, weight loss, failure to thrive including lack of weight gain and persistent coughing or wheezing, Mulberg says.

PPIs: Yes or No?

Many parents are worried enough to try over-the-counter (OTC) medications, including proton pump inhibitors (PPIs) such as Prilosec. PPIs work by reducing the amount of stomach acid made by glands in the lining of your stomach and are often used by adults to treat GERD, commonly known as heartburn.

However, PPIs sold over the counter are not approved by FDA to treat reflux in infants, says Mulberg.

An FDA advisory committee met in November 2010 to discuss four clinical trials investigating the effects of PPI treatment of infant GERD. The committee concluded that PPIs should not be prescribed as therapy for otherwise healthy infants less than 1 year old, Mulberg says, unless there is evidence of tissue erosion in the esophagus.

As for what drugs may or may not be needed, that's a determination the health care professional must make after conducting a thorough physical examination. Mulberg suggests that parents should be ready to discuss the baby's mealtime behaviors in some detail, as well as the child's general mood. Before an appointment, parents should be prepared to answer questions such as:

Does the baby spit up at every feeding?

How much liquid is the baby spitting up?

Are you breast-feeding?

If not breast-feeding, what type of formula are you using?

Have you recently switched formulas?

Ways to Cope With Normal Spitting Up

Once a more serious disease is ruled out by the health care professional, there are a number of things parents and other caretakers can do to help prevent babies from constantly spitting up. These include:

Holding the baby in an upright position when feeding.

Feeding the baby smaller portions at a time.

Making a switch to a different formula.

"It's understandable why new parents, especially, are worried when their child seems to be spitting up nonstop," Mulberg says. "Generally, the parents are pretty sleep deprived, too—which doesn't help the situation."